Progress on Global Health Goals: Are the Poor Being Left Behind?

Abstract

We examine differential progress on health Millennium Development Goals (MDGs) between the poor and the better off within countries. Our findings are based on an original analysis of 235 DHS and MICS surveys spanning 64 developing countries over the 1990-2011 period. We track five health status indicators and seven intervention indicators from all four health MDGs. In approximately three-quarters of countries, the poorest 40 percent have made faster progress than the richest 60 percent on MDG intervention indicators. On average, relative inequality in these indicators has been falling. However, in terms of MDG outcome indicators, in nearly half of the countries, relative inequality has been growing. Moreover, in approximately one-quarter of the countries, the poorest 40 percent have been slipping backwards in absolute terms on both MDG interventions and outcomes. Despite reductions in most countries, relative inequalities in MDG health indicators are still appreciable, with the poor facing higher risks of malnutrition and death in childhood and lower odds of receiving key health interventions. With only a few months to go until the December 31, 2015, target date for the attainment of the Millennium Development Goals (MDGs), global and country-specific progress toward the health-related MDGs is being fervently discussed by ministries of health, development partners, civil society organizations, and health advocates. Recent estimates (Go and Quijada 2012; United Nations 2012; World Bank 2013) show that although progress toward most non-health MDG targets is largely on track, progress toward the health MDG targets is not. Largely absent from the discussion on the health MDGs has been the question raised by Gwatkin (2005) nearly 10 years ago: whether progress within countries has been pro-poor (i.e., faster among the poor and hence inequality reducing) or prorich. 1 Only three studies have shed light on this question, and, as we show below, these studies reached different conclusions. As a result, it is currently unclear

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